| NPI | 1265099550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1907) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR R5529) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2023-04-03 |